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Assessing the Value of Anastomotic Connectors in Robotically Assisted Totally Endoscopic Coronary Artery Bypass Grafting
Stephanie L. Mick1, Leonardo Canale1, Jeffrey D. Lee1, A Marc Gillinov1, Tomislav Mihaljevic2, Johannes Bonatti2.
1Cleveland Clinic, Cleveland, OH, USA, 2Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.

OBJECTIVE: It is commonly believed that the use of automatic anastomotic devices holds the potential to simplify robotic totally endoscopic coronary artery bypass grafting and to decrease operative time. We compared robotically sewn distal anastomoses to device-created anastomoses in a porcine wet lab model.
METHODS: In each case, the right coronary artery was dissected free from a cadaveric pig heart and then anastomosed to the LAD, simulating a LIMA to LAD anastomosis. In group A, a graft to coronary anastomosis was created using a running 7-0 Pronova suture with DaVinci Si robotic assistance. In group B, each anastomosis was performed using the C-Port Flex-A automatic anastomotic connector (Cardica, Redwood City, CA) with DaVinci Si robotic assistance. The anastomoses were inspected and probed to confirm patency.
RESULTS: The anastomotic time was 294 +/-16 seconds in group A and 260 +/- 42 seconds in group B (p = 0.094). In the connector group, the times for device loading, positioning/firing and repair of the anvil hole were 116 +/-18, 53 +/-39, 90 +/-12 seconds respectively. All anastomoses in both groups were patent.
CONCLUSIONS: Both sewing and device construction produce simulated LIMA-LAD anastomoses of adequate quality. Use of an automatic anastomotic connector may slightly decrease anastomotic time however the clinical relevance of this is uncertain.


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